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Non-alcoholic fatty liver disease and hepatocellular carcinoma: Clinical challenges of an intriguing link

Authors
  • Chrysavgis, Lampros
  • Giannakodimos, Ilias
  • Diamantopoulou, Panagiota
  • Cholongitas, Evangelos
Type
Published Article
Journal
World Journal of Gastroenterology
Publisher
Baishideng Publishing Group Inc
Publication Date
Jan 21, 2022
Volume
28
Issue
3
Pages
310–331
Identifiers
DOI: 10.3748/wjg.v28.i3.310
PMID: 35110952
PMCID: PMC8771615
Source
PubMed Central
Keywords
Disciplines
  • Review
License
Unknown

Abstract

Non-alcoholic fatty liver disease (NAFLD) has emerged as the most common liver disorder worldwide mainly attributed to the epidemic spread of obesity and type 2 diabetes mellitus. Although it is considered a benign disease, NAFLD can progress to non-alcoholic steatohepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). Most data regarding the epidemiology of NAFLD-related HCC are derived from cohort and population studies and show that its incidence is increasing as well as it is likely to emerge as the leading indication for liver transplantation, especially in the Western World. Although cirrhosis constitutes the main risk factor for HCC development, in patients with NAFLD, HCC can arise in the absence of cirrhosis, indicating specific carcinogenic molecular pathways. Since NAFLD as an underlying liver disease for HCC is often underdiagnosed due to lack of sufficient surveillance in this population, NAFLD-HCC patients are at advanced HCC stage at the time of diagnosis making the management of those patients clinically challenging and affecting their prognostic outcomes. In this current review, we summarize the latest literature on the epidemiology, other than liver cirrhosis-pathogenesis, risk factors and prognosis of NAFLD-HCC patients. Finally, we emphasize the prevention of the development of NAFLD-associated HCC and we provide some insight into the open questions and issues regarding the appropriate surveillance policies for those patients.

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